Video Archives

Pros and Cons of the ReIMAGINE Trial

Posted by Matthew R. Cooperberg, MD, MPH | Apr 2024

Matthew R. Cooperberg, MD, MPH, discusses the strengths and weaknesses of the Risk and Screening arms of the ongoing ReIMAGINE trial. He begins by describing the two arms of the study, ReIMAGINE Screening and ReIMAGINE Risk, and then focuses on the Screening arm, digging into the participant data.

Dr. Cooperberg addresses the sequence of screening tests in the ReIMAGINE trial, and reasserts the value of PSA as an initial screening marker, using supporting evidence from the ongoing STHLM3-MRI trial.

Dr. Cooperberg concludes by explaining that ReIMAGINE Risk will be useful as a biorepository in the future. While ReIMAGINE Screening shows PSA with magnetic resonance imaging (MRI) is better than PSA alone, he reiterates that as a first screen, PSA <1 (or 1.5) is tough to beat. Dr. Cooperberg explains that MRI is useful for helping to guide biopsy and is acceptable as a second screening tool. However, other markers are more effective and less expensive in the United States.

Fusion Biopsy Technologies and Techniques

Posted by Peter A. Pinto, MD | Apr 2024

Peter A. Pinto, MD, discusses the evolution of prostate cancer biopsy and imaging techniques in the past twenty years, from blind systematic biopsies to MRI-ultrasound fusion biopsies. He begins by noting that prostate cancer was the only solid-organ tumor diagnosed without image guidance going into the 21st century.

When MRI was introduced as an imaging modality for prostate cancer diagnosis, urologists developed several different techniques for incorporating MRI into biopsy procedures. Dr. Pinto briefly covers the history and development of in-bore biopsies, cognitive fusion biopsies, and MRI-ultrasound fusion biopsies.

He concludes with reviewing the currently available devices in this space. He evaluates each system as it relates to biopsy needle targeting route, tracking and navigation, MRI-ultrasound fusion opportunities, ultrasound image acquisition, and biopsy fixation.

Practical Steps for Clinical Efficiency Relative to Physician Burnout

Posted by Ryan P. Terlecki, MD, FACS | Apr 2024

Ryan P. Terlecki, MD, FACS, offers actionable steps to keep a clinical practice efficient in the face of the epidemic of physician burnout. In this presentation, he discusses how the first step in keeping an efficient and effective practice is to develop a familiarity with:

The Differences Between Efficiency and Effectiveness
The Role of Planning, Consistency, and Reevaluation in Quality Improvement
Management Strategies Which Prioritize Workflow and Well-Being

Dr. Terlecki frames burnout management around a few key principles for efficient and effective clinical practice. He provides real-world examples and applications of these steps to combat and compensate for physician burnout in both practice and academic settings.

Treatment of Male Stress Urinary Incontinence

Posted by Brian S. Christine, MD | Apr 2024

Brian S. Christine, MD, provides guidance on the assessment and treatment of stress urinary incontinence (SUI) after radical prostatectomy. Dr. Christine begins by discussing the pelvic support changes that happen in men post-prostatectomy, the relationship between the loss of pelvic support and incontinence, and the different mechanisms behind moderate and severe SUI.

Dr. Christine encourages urologists to assess each post-prostatectomy patient presenting with SUI symptoms using a thorough work-up to determine SUI mechanism and severity, an awake cystoscopy to visualize the function of the external sphincter, and a Standing Cough Test. He explains that these three steps in SUI assessment allows the attending physician to ensure that the treatment will match the severity and mechanism of the patient’s incontinence.

He then explores the process of selecting the optimal treatment between the two principal surgical options for treating male SUI: the male sling and the artificial urinary sphincter. Dr. Christine reiterates the importance of tailoring the therapy based on the information gathered during the assessment, and advises urologists to visit surgeon educators on-site and develop their surgical placement skills.

Dr. Christine concludes by exploring the treatment of recurrent SUI in men who have been previously treated for SUI. He provides guidance on treating men with a prior male sling and men with a malfunctioning or affected artificial urinary sphincter.

Posterior Urethral Stenosis: BNC after BPH Surgery

Posted by Brian J. Flynn, MD | Apr 2024

Brian J. Flynn, MD, discusses bladder neck contracture, its frequency, causes, and management options. This 10-minute presentation begins with an overview of bladder neck stenosis terminology, emphasizing its iatrogenic nature primarily resulting from surgical interventions on the prostate, such as transurethral procedures. Flynn highlights the importance of understanding patient history and conducting thorough evaluations, including uroflow studies, post-void residual measurements, and cystoscopy.

Different surgical techniques for reconstruction are covered, with photographs, videos, and illustrations aiding the discussion. Dr. Flynn also reviews preventive measures to avoid subsequent complications, emphasizing precise surgical techniques, including careful incision placements and energy application to minimize damage. Flynn shares personal experiences with cases, highlighting the importance of accurate diagnosis and treatment planning.